MEDICARE: THRIVE COUNSELING OF NORTHERN VIRGINIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1215681325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE COUNSELING OF NORTHERN VIRGINIA, LLC

Provider Business Mailing Address
First Line	:	8500 LAKINHURST LN
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1727
Country	:	US
Telephone Number	:	571-609-3507
Fax Number	:

Provider Business Practice Location Address
First Line	:	3060 WILLIAMS DR STE 300
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4648
Country	:	US
Telephone Number	:	571-609-3507
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/CO-OWNER
Name	:	ELIZABETH DIAZ
Credential	:	LPC, LMHC, NCC
Telephone Number	:	571-609-3507

Provider Enumeration Date	:	02/08/2022
Last Update Date	:	04/28/2025

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